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Medical Problems Meds
=Common Medical Problems and Medications to have on board= :Roy Verdery, MD, Internal Medicine (medicine for adults) :February, 2009 Disclaimer - read this first! Do not use these general rules for children or pregnant women without input from a pediatrician or an obstetrician. This information is provided for educational purposes only and to assist people who may be some distance from a physician in making informed decisions. It is not designed to substitute for professional care or to teach medicine to non-physicians. There may be errors and omissions in spite of efforts to be accurate and complete. Get help if the problem doesn’t get better in 3 days, gets worse, or isn’t nearly gone in 7 days. In all cases it is better to see a physician or other health care provider or to communicate with a physician by any means available than to treat yourself or to act as a doctor without proper training and credentials. Local physicians have lots of experience, even if they weren’t trained in the US, Canada, or EU. 90% of medical problems are self-limited and require no treatment at all and a doctor who takes care of himself has a fool for a physician. '' When taking care of other people, remember that the first rule is to do no harm.'' =Getting medical assistance= For serious problems In 2009, the standard is to get help and evacuate to a major medical center. Before buying a complex medical kit, buy a satellite phone and keep handy a telephone number of a physician you can count on and the U.S. Coast Guard. Additionally, there are thousands of Hams waiting 24 hr per day on single sideband radio (SSB) at 14300 kHz upper sideband to help in emergencies; and of course, the local VHF and SSB radio nets have people with vast amounts of experience and resources who will help you. Cruising is a social activity and there are many people who are willing to help. Pharmacists Outside of the U.S., Canada, U.K., and the E.U. pharmacists are not usually credentialed. Often they are just salespeople who sell medications. Be very careful accepting the advice of pharmacists, even for simple problems such as colds and diarrhea. Medication names Generic medication names are primarily used in the following notes. These are the names most recognizable by pharmacists and physicians in various countries. Unfortunately there are three different lists of generic names: the U.S., the U.K., and WHO (which seems to have chosen from the U.S. and U.K. lists). In Mexico, the WHO list is used. For example, Tylenol is the brand name for U.S. acetaminophen and U.K. paracetamol. Mexico uses the WHO generic name paracetamol for this drug. Read the ingredients of combination drugs, such as cold medications carefully. Many combination drugs contain sedatives and stimulants or use doses which are not approved for sale over the counter in the U.S., Canada, U.K., or E.U. =Common problems expected= Based on experience with around the world sailors, an otherwise healthy cruiser can expect to have 4 medical illnesses a year: 1 stomach ailment (heartburn, gastroenteritis, or diarrhea), 1 cold, 1 rash, and 1 episode of seasickness or other common problem. The same cruiser can expect to have 3 injuries per year: 1 scrape or bruise, 1 sprain or minor fracture, and 1wound or burn. Head injuries occur about once every 5 years of cruising. You should prepare yourself for the common problems that can be expected and for the simple problems that anyone might encounter in day to day living. Common expected problems and over-the-counter (otc) medications needed: Medications for Common Problems Heartburn Calcium carbonate (Tums), magnesium and aluminum hydroxide antacid (Maalox or Mylanta), ranitidine (Zantac), omprazole (Prilosec), or famotidine (Pepcid). Diarrhea Oral hydration electrolytes or know how to make oral hydration fluid, Immodium AD, Peptobismol. Gastroenteritis Oral hydration electrolytes or know how to make oral hydration fluid. Cold or flu Acetaminophen (Tylenol), dm cough syrup, throat lozenges, sudafed, benadryl, favorite otc cold medication. Rash 1% hydrocortisone cream, antifungal cream (terbinifine, lotrimin, tolnaftate, miconazole, clotrimazole, or ketoconazole). Allergy Loratidine (Clariten), tylenol, ibuprofen, or naproxen for itch. Seasickness Meclizine (Non-drowsy Dramamine), diphenhydramine (Dramamine), compazine phenergan, sturgeron, and/or transdermal scopolamine. Scrape or bruise Soap and water, antibiotic cream, bandaids and other sterile bandages. Sprain or minor fracture Ace bandage and/or splint, ice, tylenol, ibuprofen, naproxen, or other nonsteroidal antiinflammatory. Wound Soap and water, antibiotic cream, sterile bandages. Burn Antibiotic cream, sterile bandages, tylenol, ibuprofen, or naproxen =Less common problems= :(with some repeats) and medications to consider: :Format Test with a Table =Still to Edit= stroke aspirin - get help, probably little to do but assisting someone with a new stroke willplace other people at risk Eyes red eyes artificial tears allergies nafcon a antihistamine conjunctivitis gentamycin or cipro drops dilated from transderm scop very dark glasses, patch vision loss get professional help Ears external ear pain debrox, olive oil - NOT IF EARDRUM IS PERFORATED (use otoscope to see eardrum) external ear infection cortisporin drops - NOT IF EARDRUM IS PERFORATED (use otoscope to see eardrum) middle ear pain decongestants: sudafed + afrin middle ear infection antibiotic: tm-smx or amoxicillin perforated ear drum decongestants: sudafed + afrin Nose allergies sudafed, benadryl, loratadine runny nose from colds time Mouth sores salt water rinse thrush (rare) antibiotic: clotrimazole suppository Teeth / gums infection antibiotic: penicillin vk , amoxicillin, or clindamycin (if allergic to penicillin) Throat sore throat symptom relief, throat lozenges, tylenol, time Neck stiff neck warmth, exercise, tylenol, Shoulders / arms aches and pains exercise, tylenol, ibuprofen , naproxen, or other nonsteroidal antiinflammatory Chest respiratory infection Symptom relief: dm cough syrup, tylenol for fever, aches. Most colds and flu starting with runny nose and sore throat and developing cough are caused by viruses and will get better in 7-10 days. If they persist longer, recur, are accompanied by high fever, chest pain or bloody phlegm an antibiotic and inhaler may be useful. cough dm cough syrup bronchitis dm cough syrup, albuterol inhaler, if not better after 1 week antibiotic: azithromycin or doxycycline pneumonia dm cough syrup, albuterol inhaler, antibiotic: azithromycin or doxycycline asthma albuterol inhaler, consider prednisone palpitations nothing unless accompanied by faintness or confusion pain call for help - potentially dangerous, If cardiac consider aspirin, nitroglycerin, atenolol or metoprolol; if associated with infection consider ibuprofen or naproxen. blood in phlegm common complication of bronchitis or pneumonia, dangerous sign of cancer otherwise, large amounts require help Abdomen indigestion, reflux antacid such as tums or maalox, acid blocker such as zantac, proton pump inhibitor such as prilosec or pepcid nausea, vomiting fluids, oral rehydration electrolytes if dehydrated, dimenhydrinate (Dramamine), meclizine, transderm scop, consider phenergan, compazine, or sturgeron, but these have severe side effects pain watch, potentially dangerous if persistent more than 24 hours or accompanied by vomiting, fever, or distention - get help Genitourinary urinary infection fluids, tm-smx, cipro, nitrofurantoin, doxycycline for men kidney infection fluids, tm-smx, cipro, potentially dangerous if persistent or accompanied by fever and vomiting yeast infection fluconazole or topical “azole” pregnancy call for help, first 2 trimesters of pregnancy on ship is probably safe if it is a low-risk pregnancy and ultrasound is normal. See the CDC information for more advice on traveling anywhere when pregnant. Bowels diarrhea fluids, immodium, peptobismol, consider cipro or tm-smx for 3 days, oral rehydration electrolytes if dehydrated. Complex diarrhea - persisting more than 7 days without improvement or recurrent - must be considered separately. recurrent diarrhea fluids, metamucil, consider flagyl constipation fluids, metamucil, docusate, milk of magnesia, enema if severe bleeding get help - consider time only if you have hemorrhoids Hips and legs aches and pains exercise, tylenol, ibuprofen, naproxen or other nonsteroidal antiinflammatory Skin rash dryness, 1% cortisone cream rash miconazole or other antifungal cream boils, pustules open sterilely, keflex, tm-smx, doxycycline infection antibiotics: tm-smx, doxycycline, keflex jellyfish stings vinegar, alcohol (not fresh water) stingray punctures hot water Non-prescription medications mentioned are listed below with approximate dosing. It is best for them to be taken as directed on the package or bottle. Be careful to avoid medication allergies. • acetaminophen (Tylenol), 325 or 500 mg, 1-2, 4 times daily, risk of overdose with more than 8000 mg / day • ibuprofen 200 mg otc, 1-2, 4 times daily, risk of stomach pain, bleeding from the stomach, and ulcers (take omeprazole or pepcid to prevent stomach problems) • naproxen 250 (220 otc, Aleve) mg, 1-2, 2 times daily, risk of stomach pain, bleeding from the stomach, and ulcers (take omeprazole or pepcid to prevent stomach problems) • nonsteroidal antiinflammatories include many drugs (e.g. salsalate, trisilate, ibuprofen, ketoprofen, naproxen, diclofenac, etodolac, indomethecin, ketorelac, nabumetone, sulindac, tolmetin, meclofenamate, meloxicam, prioxicam, celecoxib) with similar benefits. All require different doses and dosing intervals, all have risk of stomach pain, bleeding from the stomach, and ulcers (take omeprazole or pepcid to prevent stomach problems) • aspirin, 325 mg, 1-2, 4 times daily (1, once for cardiac chest pain) • artificial tears eye drops, 1-2 drops in both eyes as needed • Nafcon a eye drops, 1-2 drops in both eyes, 1-2 times daily • Debrox ear drops, 2 drops in the affected ear, 2 times daily, not if eardrum is perforated • pseudoephedrine (Sudafed), 30 mg, 1-2 up to 4 times daily, raises blood pressure, causes insomnia • Afrin nasal spray, both nostrils up to 4 times daily, habit forming (if you stop you get worse) • diphenhydramine (Benadryl), 12.5 - 50 mg up to 4 times daily, causes sleepiness • loratadine, 25 mg daily • clotrimazole suppositories, dissolve in the mouth 4 times daily for thrush (yeast infection) • dm cough syrup (e.g. Robitussin dm, Honey dm), 1 teaspoon every 3 hours • throat lozenges, dissolve in mouth as needed • calcium carbonate (Tums), 2 every 2 hours as needed • magnesium and aluminum hydroxide (Maalox or Mylanta), 2 tablespoons every 2 hours as needed • zantac (Ranitidine), 150 mg, 1-2, 1 time or 2 times daily • omeprazole (Prilosec) or famotidine (Pepcid), 20mg, 1 in the morning • oral rehydration fluid made from packaged electrolytes or mix 1/2 teaspoon salt, 1/2 teaspoon baking powder, 1/4 teaspoon potassium chloride, and 2 tablespoons sugar or corn syrup in 1 quart of water. Even simpler, use 1/2 teaspoon salt and 1 tablespoon sugar in 1 quart water. • dimenhydrinate (Dramamine) 12.5 - 25 mg to 4 times daily, causes sleepiness, ok for children • meclizine (Bonine) 12.5 - 25 mg twice daily • scopolamine patch (Transderm Scop), ½ -1 patch to skin every 3 days, wash hands after applying. If you get scopolamine in your eye it will dilate the pupil on that side - patch the eye, wear dark glasses, and wait for the pupil to return to normal. • phenergan 12.5 - 25 mg twice daily • compazine 12.5 -25 mg twice daily • cinnarizine (Stugeron), 15 mg twice daily for seasickness per U.K pharmacopoeia, not for children (Warning: 75 mg tablets are used for heart disease, not seasickness.) • topical “azole” (miconazole, clotrimazole, butoconazole, terconazole, or tioconazole, e.g. Monistat 3 or 7) for vaginal yeast infections • immodium 2.5 mg, 2 with loose bm and 1 with next loose bm to 6 per day maximum • bisthmus subsalicylate (Peptobismol), 2 tablespoons or 2 wafers every 2 hours as needed, turns stools black • Metamucil, 1 teaspoon with 8 oz glass of water or juice twice daily, for constipation or persistent loose stools after episode of diarrhea. (Not a laxative, just provides bulk.) • docusate sodium, 200 mg, 1-4 times daily, for constipation • magnesium hydroxide (Milk of Magnesia), 2 tablespoons, 1-4 times daily if no bm in 2 days • enema, if constipated more than 3 days • hydrocortisone 0.5 - 1% cream • antifungal cream (terbinifine, lotrimin, tolnaftate, miconazole, clotrimazole, or ketoconazole creams are similar, but one may work when another doesn’t) Prescription medications mentioned are listed below, with approximate dosing based on The Sanford Guide to Antimicrobial Therapy 2008. Be very careful to avoid allergies. There are many alternatives, discuss them with your physician. • gentamycin eye drops 1 drop, every 2 hours while awake for 3 days, may cause redness • tobramycin eye drops 1 drop, every 2 hours while awake for 3 days, may cause redness • cortisporin ear drops 1-2 drops, 2 times daily for 3 days • trimethoprim / sulfamethoxazole (tm-smx, Bactrim) 160 / 800 mg, 2 times daily for 7 days, sulfa - consider allergies • amoxicillin 500 mg, 3 times daily for 7 days, penicillin - consider allergies • penicillin vk 500 mg, 4 times daily for 7 days, penicillin - consider allergies • ciprofloxacin (Cipro) 500 mg, 2 times daily for 7 days (3 days for diarrhea), not for children • doxycycline 100 mg, 2 time daily for 7 days • nitrofurantoin 50 mg, 4 times daily for 7 days (macrobid 2 times daily is same) • macrobid 100 mg, 2 times daily for 7 days • albuterol inhaler 2 puffs, 4 times daily and every 2 hours as needed • prednisone 5 mg, 4 tablets one time a day for 3 days, then 2 tablets one time a day for 3 days, then 1 tablet daily for 3 days (many versions of this regimen are commonly recommended, discuss with your physician) • clindamycin 300 mg, 4 times daily for 7 days • cephalexin (Keflex) 500 mg, 4 times daily for 7 days • nitroglycerin 0.4 mg, 1 under the tongue every 5 minutes while lying down • atenolol 25 mg, 1daily for cardiac chest pain, not with metoprolol • metoprolol 25 mg, 1 2 times daily for cardiac chest pain, not with atenolol • metronidazole (Flagyl) 500 mg, 4 times daily for 7 days Carry inexpensive medications and keep them up-to-date. There are no controlled trials addressing shelf life. It is certainly shorter in hot and humid weather. Recommended references: (Note that many popular books on medicine are out of date. Beware of any book published more than 5 years ago.) Weiss, Eric A. and Jacobs, Michael: A Comprehensive Guide to Marine Medicine. Adventure Medical Kits, Oakland, CA. 2005. The formula for oral hydration solution has typographical errors. Arguin, Paul, M., Kozarsky, Phyllis E., and Reed, Christie, eds. CDC Health Information for International Travel. Elsevier Mosby, Philadelphia, PA. 2008. The formula for oral hydration solution has typographical errors. *'© Roy Verdery 2009'. All rights reserved. Permission to copy these notes is granted for noncommercial purposes only.